Patient Care Report Form (EMS)

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A Patient Care Report is generated whenever Collierville Fire Department assists a sick or injured person. These reports contain confidential personal health information (PHI) and are not part of the public record. 

Copies of Patient Care Reports are available to our patients, their representatives and others as specified by Tennessee Code Annotated (TCA). The Fire Department's policies and procedures for the release of patient care reports comply with restrictions specified under state law. At the same time, the Fire Department strives to make the process of obtaining copies of records as easy as possible for those seeking them.

The fee for a Patient Care Report is $10- cash, check, or money order payable to the Collierville Fire Department.
 
You can request a copy of a Patient Care Reports by either contacting the Fire Records Administrator or submitting your request electronically with the form below.  

Renee Langley, Fire Records Administrator
1251 Peterson Lake Road, Collierville, TN 38017
rlangley@colliervilletn.gov or (901) 457-2481 
Mon-Fri 7am-4pm (excluding holidays)

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